Tarika feels tired all the time. She is in her mid-thirties. She is on her feet all day and when she comes home, her legs and knee joints ache. She has always avoided milk since it does not agree with her. Could she have calcium deficiency? Tejasvi reached menopause 3 years ago. Does she require calcium supplementation?
We are all aware of how important calcium is for growing children. Every mother emphasises the need for milk and curds for her children. However, as women grow older, they neglect their body's need for calcium.
Why do you need calcium?
Calcium is one of the key nutrients essential for healthy bone development. Peak bone mass is usually reached in the late teens. This means that by the time you have reached the age of 20, you have accumulated the maximum bone mass.
Other than its importance for strong bones, calcium is essential for the function of various organs within the body. If blood calcium levels fall, the body will compensate for this by pulling calcium out of bones. The body also excretes calcium daily. Therefore, to maintain the balance of calcium in the body, it is essential to have adequate calcium intake throughout life.
How much calcium do you need?
The recommendation for calcium intake is 1000 milligrams for women between 25-50 years. After menopause, women require 1000-1500 milligrams per day. This refers to elemental calcium . Most women will get their calcium requirement from dietary sources. If you are on a calcium supplement, make sure you look at the label and find out how much elemental calcium is present in each tablet.
Calcium requirements throughout life
Childhood and adolescence is when the skeleton is actively growing. Calcium intake in that age group should be enough to provide the requirements of the growing skeleton. That is why it is important for adolescent girls to get adequate calcium from dairy products and other dietary sources, to ensure strong, healthy bones.
Dr. Usha Sriram, a leading endocrinologist in Chennai says, “A good rule of thumb regarding natural sources of calcium is that 3 cups of milk = 8 cups of greens (keerai) = 5 cups of red kidney beans (rajma). It is therefore important to include a combination of dairy products, greens and whole lentils in our diet.” Exercise, too, plays a big role in building strong bones.
Women in their 20s-40s usually have a stable amount of bone gain and loss. Women who have built up a good amount of bone density in their adolescence will be able to withstand bone loss better.
Menopause and beyond At menopause and after menopause, calcium requirement goes up. In the years after menopause, there is a rapid loss of bone that is primarily due to estrogen deficiency. This process may last from 4–8 years after menopause. Inadequate calcium intake can accelerate bone loss, leading to osteoporosis . Calcium supplementation and adequate exercise (like brisk walking) will maintain bone mass and will decrease the rate of bone loss after menopause.
Calcium supplements
Children and young women do not routinely require calcium supplements. They should be able to meet their calcium requirements from dietary sources like dairy products, green leafy vegetables, lentils and nuts. Pregnant women need more calcium but this can be usually achieved by increasing their dietary intake of calcium-rich food. Menopausal women definitely require calcium supplements. They need 1000 milligrams of elemental calcium per day. Calcium is best taken with meals. Taking calcium supplements with your meals also reduces the risk of developing kidney stones. If you have been prescribed 1000 milligrams, take it in two doses of 500 milligrams each. Do not take calcium and iron tablets together.
Women with lactose intolerance should take other dietary sources of calcium and may require calcium supplements.
A calcium supplement should also contain Vitamin D3 . Vitamin D is essential for promoting calcium absorption and for bone growth. Together with calcium, vitamin D helps protect older adults from osteoporosis. Vitamin D is absorbed from the skin in sunlight. Older women who are homebound and women who wear long robes and head coverings for religious reasons are unlikely to obtain adequate vitamin D from sunlight. A calcium supplement with 500 milligrams of elemental calcium should also contain 400-500 IU of Vitamin D3.
The author is an obstetrician and gynaecologist practising in Chennai and has written the book 'Passport to a Healthy Pregnancy'.
www.passport2health.in
